The Spine Journal Devotes Powerful Issue to Casualties of War

BURR RIDGE, Ill., Oct. 17, 2012 (GLOBE NEWSWIRE) -- While the long wars in Iraq and Afghanistan have introduced the world to the devastation of catastrophic blast injuries, a leading cause of medical evacuation from Iraq and Afghanistan is actually non-battle spinal pain. This and other surprising data are featured in the September issue of The Spine Journal, which is devoted to casualties of war.

"While some of the findings in this special issue are new and specific to these long wars—such as the devastating effects of IED blasts—it's clear that we need to re-learn some very old lessons about war," said Editor in Chief Eugene J. Carragee, MD, of the Stanford University School of Medicine, Redwood City, CA. Carragee served as Command Surgeon for a special operations unit in several theaters, including Iraq and Afghanistan, and retired as a Lieutenant Colonel in 2010.

"We repeatedly send young people into combat to experience the worst psychological stressors possible, push them beyond endurance, and yet on the home front there is little to no collective understanding of the wars they fought or the experiences of deployment and combat," said Dr. Carragee. "Veterans seeking care for spine problems at home are shown to have continued serious psychological distress, associated with exposure to combat. This is a serious public health issue that will continue for many years."

According to Ronald A. Lehman Jr, MD, of the Walter Reed National Military Medical Center, Bethesda, MD, this special focus issue will help to fill the considerable gap in knowledge and understanding so that clinicians can better care for our nation's heroes at home and abroad.

"Unlike any previous period in our nation's history, we have documented many of the challenges faced by spine providers in taking care of the unique injuries sustained in combat operations in Iraq and Afghanistan," said Dr. Lehman, who has treated hundreds of soldiers with non-battle and combat-related spine injuries. Dr. Lehman served as this issue's co-editor and co-authored several of the studies.

Key Findings

  • As terrible as the blast injuries of current conflicts may be, there have been 10 times as many long-term spinal pain casualties unrelated to the physical injuries of battle.
  • Musculoskeletal pain and spine pain syndromes are by far the most common cause of evacuation from Iraq and Afghanistan. (30-35%)
  • With the loss of mission focus in Iraq during 2005 and 2006, combat casualties decreased, but both spinal pain and psychiatric casualties dramatically increased.
  • With increased mission focus of the Iraq "Surge" in 2007, spinal pain casualties dropped by a third.
  • After being medically evacuated from Iraq with nonbattle-related spinal pain, patients have less than a 20% chance of returning to their unit and regular duty.
  • 60% of veterans seeking care for spine problems have serious continued psychological distress.
  • Today's soldiers and their burdens after combat are virtually invisible to society. During World War II, nearly 50% of military-aged Americans served in the military. Today, that number is less than 1%.

The September special focus issue features:


* "Marching home, again: spine casualties, combat exposure, and the long wars"
* "Military contributions to spine care"
* "A history of military spine surgery"

Review Articles

* "Are spine injuries sustained in battle truly different?"
* "Evaluation and management of combat-related spinal injuries"
* "The effect of vehicle protection on spine injuries in military conflict"
* "Spine-area pain in military personnel: a review of epidemiology, etiology, diagnosis and treatment"
* "Wartime spine injuries: understanding the improvised explosive device and biophysics of blast trauma"

Clinical Studies

* "Complications associated with military spine injuries"
* "Characterization of combat-related spinal injuries sustained by a U.S. Army Brigade Combat Team during Operation Iraqi Freedom"
* "Psychological distress in a Department of Veterans Affairs spine patient population"
* "Military penetrating spine injuries compared to blunt"
* "Epidemiology of cervical spine fractures in the United States military"
* "Predictors of short-term work-related disability among active duty, US Navy personnel: a cohort study in patients with acute and sub-acute low back pain"
* "Low lumbar burst fractures: a unique fracture mechanism sustained in our current overseas conflicts"
* "Multiple associated injuries are common with spine fractures during war"
* "Predictors of low back pain in physically active conscripts with special emphasis on muscular fitness"
* "Back disorders among Israeli youth: a prevalence study in young military recruits"

In addition to this comprehensive research, the focus issue includes thought-provoking, firsthand commentaries about injuries and combat exposures through the years, from Ernest Hemingway to George Orwell to Pfc Jessica Lynch. This special issue is dedicated to the men and women of the armed forces and their families, past and present.

The Spine Journal is an international, multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. With a 3.290 Impact Factor, The Spine Journal is the top-rated spine journal and the third-ranked orthopedic journal in the world. Published online continuously and printed monthly by Elsevier, Inc., The Spine Journal is the scientific publication of the North American Spine Society (NASS). NASS adheres to a policy of editorial independence for the journal's editorial board, which follows guidelines of the International Committee of Medical Journal Editors, Committee on Publication Ethics and other best editorial practices.

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CONTACT: Nicolle Heller (630) 230-3650 or

Source:North American Spine Society